Vision Loss in Guillain-Barre Syndrome: Is it a Complication of Guillain-Barre Syndrome or Just a Coincidence?

Abstract

340 © 2016 Journal of ophthalmic and Vision research | published by Wolters KluWer medKnoW Dear Editor, We report a 15-year-old girl who presented to us with a history of progressive weakness of both upper and lower limbs for 2 days before. On examination, the power of lower and upper limbs were 2/5 and 4/5, respectively. She had decreased tone and areflexic quadriparesis with mute plantar. The patient was clinically diagnosed to have Guillain-Barre syndrome (GBS). Nerve conduction studies confirmed GBS with both axonal and demyelinating polyradiculoneuropathy. Cerebrospinal fluid (CSF) analysis showed albuminocytological dissociations. Over the next 2 days, her weakness rapidly progressed to respiratory failure, and she was intubated and ventilated and was closely monitored. Her blood pressure (BP) fluctuated between 190/130 mmHg to 140/90 mmHg and labetalol was used intermittently to reduce BP. She was started on IVIG 20 gms/day for 5 days; however, on day 14 of admission she had 2 episodes of generalized seizures and was treated with antiepileptics. She was weaned from ventillator after 4 weeks. Although her muscle power improved, she complained of light perception vision loss in both eyes. In the clinical evaluation, her direct and indirect pupillary reflexes, fundus examination using direct ophthalmoscopy and extraocular movements were normal. Magnetic resonance imaging (MRI) of the brain revealed bilateral pariteo-occipital T2/FLAIR hyperintensity and diagnosis of posterior reversible encephalopathy syndrome (PRES) was made [Figure 1a and b]. The patient gradually improved over the next month to regain complete vision and most of the muscle power with conservative treatment. Vision Loss in Guillain-Barre Syndrome: Is it a Complication of Guillain-Barre Syndrome or Just a Coincidence?